Introduction. Extracorporeal perfusion of transplants is proposed as one of the areas to expand the pool of donor hearts. Important aspects are the establishment of optimal perfusion parameters, which is of particular importance in prolonged perfusion.

Objective. To present the results of the development of a perfusion module for extracorporeal anti-ischemic protection of donor hearts.

Material and methods. A perfusion module for extracorporeal anti-ischemic protection of donor hearts was developed on mature outbred male rats. After 12-hour hypothermic extracorporeal perfusion of the heart in the perfusion module with +8°С oxegenated HTK solution, its function was studied.

Results. In the hypothermic perfusion group on the module, sinus rhythm was observed with a heart rate of 268.5 (256.2;279.0) beats/min; the left ventricle-developed pressure (LVDP) was 65.5 (65.0;70.7) mm Hg, by the end of the 1^st hour, the LVDP was 73.0 (70.5;75.0) mm Hg, after 90 minutes the LVDP was 82.0 (80.5;83.5) mm Hg, by the end of the 2^nd hour, the LVDP was 82.5 (80.5;84.0) mm Hg, which indicated the cardioprotective potential of hypothermic perfusion. The hearts of the control group had sinus bradycardia with a heart rate of 113.5 (90.0;124.7) beats per minute. The LVDP was 27.5 (25.5;30.0) mm Hg by the end of the 30-minute cardiac stabilization period; by the end of the 1^st hour, LVDP was 22.0 (20.5;23.7) mm Hg; by the 90^th minute the contractile function of the hearts was absent, which indicated the development of myocardial damage.

Conclusion. Obtained data indicate that the module can maintain the viability of the donor heart for 12 hours by hypothermic perfusion with +8°С oxygenated HTK solution at flow rate of 0.3 ml/min and pressure of 10 cm H₂O and pO₂ 600-700 mm Hg, which is accompanied by heart rate of 325.0 beats/min and LVDP of 82.5 mm Hg, compared to non-perfusion conservation.

Background. Thrombocytopenia is a frequent complication of liver cirrhosis that significantly increases the risk of hemorrhagic complications and limits the possibilities of invasive diagnostic and therapeutic procedures. Currently, two fundamentally different approaches are used to correct this condition: pharmacological therapy with thrombopoietin receptor agonists and invasive methods such as partial splenic artery embolization (PSAE). This study presents a comparative analysis of the efficacy and safety of these methods in patients with liver cirrhosis and severe thrombocytopenia.

Objective. A comparison of the efficacy and safety, and optimal indications for eltrombopag versus partial splenic artery embolization in the management of thrombocytopenia in patients with liver cirrhosis and hepatic failure.

Material and methods. A single-center prospective study was conducted at Moscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin involving 59 patients with liver cirrhosis and thrombocytopenia (<50×10⁹/L). Noniclusion criteria included oncological diseases, severe renal failure (GFR <45 mL/min), and active infectious processes. Patients were divided into two groups: Group 1 (n=28) received eltrombopag therapy at a dose of 50 mg/day for 14 days; Group 2 (n=31) underwent PSAE. Efficacy was assessed by platelet count dynamics, compensation duration, and complication rates. The literature search was conducted in the following databases: PubMed/MedLine, ResearchGate, and the Russian Scientific Electronic Library (eLIBRARY.RU), covering publications from 2010 to 2024.

Results. Eltrombopag therapy achieved target platelet levels (>50×10⁹/L) in 78.6% of patients, but the effect lasted only 6 weeks on average. In the PSAE group, platelet count normalization was observed in 100% of patients 1 month after the procedure, with subsequent increase to 110±17.37×10⁹/L by week 12. The median compensation duration in this group was 50.35±9.12 weeks. Complications after PSAE were recorded in 41.9%, though mortality remained low (3.2%).

Conclusions. The study results demonstrate that PSAE provides a more sustained thrombocytopenia correction compared to the drug therapy and may be considered the method of choice for patients with hypersplenism. Eltrombopag remains preferable for short-term preparation for planned invasive procedures. While PSAE complications require careful patient selection, they do not outweigh the method's long-term benefits.

Background. Late post-transplant diseases can be latent or present as late graft dysfunction.

The objective was to assess the nature of pathological changes in liver transplant recipients in the long-term based on the severity of graft dysfunction.

Material and methods. The results of a histological examination of the liver performed no earlier than one year after transplantation in 168 recipients were studied. The median follow-up was 57.8 (26.3; 94.9) months. Graft dysfunction was defined as overt if alanine aminotransferase (ALT), aspartate aminotransferase (AST), or alkaline phosphatase (ALP) increased to more than 1.5 times the upper limit of normal (n=73). Borderline dysfunction was defined as an increase in at least one of these parameters to more than 1 but less than 1.5 times the upper limit of normal, or an increase in gamma-glutamyl transferase (GGT) to more than 1.5 times the upper limit of normal (n=37). Graft dysfunction was absent in 58 recipients.

Results. In the subgroup of recipients without graft dysfunction, a slight increase in body mass index (BMI) (+1.1 kg/ m²) was noted compared to BMI at transplantation. Recipients with the borderline graft dysfunction had a lower BMI (25.4 kg/m²), and those with the overt dysfunction had an even lower BMI (23.7 kg/m²), than the subgroup without graft dysfunction (26.8 kg/m²; p=0.015). Clinical signs of the graft dysfunction were absent in 34.5% of recipients at the time of examination; however, only 22.4% of these recipients showed no significant abnormalities on histological examination. Among the remaining recipients with normal liver tests, there was evidence of chronic hepatitis (19%), fatty liver disease (31%), or intralobular fibrosis (25.9%), and in one case, graft cirrhosis. Graft fibrosis was observed in 60.3% of recipients without graft dysfunction. Marked fibrosis (classified by the Liver Allograft Fibrosis (LAF) scoring system as LAF > 2) was detected in 31%, and significant portal tract fibrosis (assessed as the meta-analysis of histological data in viral hepatitis (METAVIR) score >2) was found in 20.7% of recipients without signs of graft dysfunction. In the subgroup of recipients with overt graft dysfunction, ductopenia was the only pathological finding in 11.1% of recipients. More than two-thirds of cases of fatty liver disease and intrahepatic fibrosis do not manifest with clinically significant abnormalities in functional liver tests. Histological examination allowed for the clarification of the cause of overt graft dysfunction in 69.4% of cases.

Conclusion. Protocol biopsies in long-term liver transplant recipients enable the detection of pathological changes of varying severity, as well as the assessment of hepatitis activity, fibrosis stage, and the cause of graft dysfunction, and the identification of autoimmune disease recurrence.

Introduction. The transplantation of primary infected grafts poses a significant challenge in the field of kidney transplantation. This issue is not adequately addressed in the existing medical literature. In our country, no systematic studies of the results of such transplants have been conducted.

Objective. To evaluate the frequency of primary infected kidney transplants and the types of microorganisms isolated from positive bacterial cultures of perfusates; to study the frequency of clinically significant infectious complications in this category of patients and their outcomes; to identify factors that had a statistically significant impact on the outcomes.

Material and methods. Between 1 January 2015 and 31 December 2024, 1,923 kidney transplants from deceased donors were performed. The study group consisted of 87 patients who tested positive for bacterial perfusion culture. Of these, 42 (48.3%) were men and 45 (51.7%) were women. The average age of the patients was 47±11.9 years. Patients were divided into two groups to assess the impact of clinically significant infectious complications on treatment outcomes: group I consisted of 15 patients with such complications and group II consisted of 72 patients without. Patients in both groups were comparable in terms of key characteristics.

Results. The frequency of initially infected kidney transplants was 4.5%. The microorganisms causing perfusion contamination were as follows: 88 bacterial strains and one fungal strain. Of these bacteria, 51 were Gram-positive, 36 were Gram-negative and one was anaerobic. Clinically significant infectious complications occurred in 17.2% of cases, with a median time to development of 9 (4;12) days. The development of infectious complications significantly reduced kidney transplant survival. Significant factors included clinically significant infectious complications, the detection of Klebsiella pneumoniae in the perfusate and type 2 diabetes mellitus in patients.

Conclusion. The frequency of primary infected kidney transplants, as well as the frequency of clinically significant infectious complications, is consistent with data from other transplant centers. Algorithms for diagnosing and treating infectious complications enabled fatal outcomes to be avoided in this patient group.

Background. Despite a complex diagnostic evaluation, the cause of ischemic stroke (IS) remains unidentified in 23-40% of cases. The implementation of endovascular thrombectomy has created the opportunities for morphological analysis of thrombotic masses.

Objective. To compare the histological structure of thrombi in patients (pts) with different subtypes of acute IS.

Material and methods. For analysis, thrombotic masses were extracted from 107 pts with IS during aspiration thrombectomy. The relationships with clinical and procedural parameters were assessed.

Results. Fractions of erythrocytes, fibrin, detritus and leukocytes in the extracted thrombi were comparable in patients with different subtypes of IS. In pts with cardioembolic IS and IS of undetermined etiology, the plasma cell count in thrombi was statistically significantly higher than in pts with atherothrombotic IS (10 (6;13) vs. 6 (4;9) number of cells, p=0.020; 10 (5;18) vs. 6 (4;9) number of cells, p=0.035, respectively).

Conclusions. Quantitative examination of clot content may be used to distinguish between different IS subtypes. We suppose on the notion that the majority of IS of undetermined etiology was associated with cardioembolic source.

Background. Ulcerative colitis (UC) is a chronic inflammatory bowel disease of unknown etiology. Up to 80% of patients with primary sclerosing cholangitis have concomitant inflammatory bowel disease. Liver transplantation is the only curative treatment for end-stage chronic diffuse liver diseases. Treatment of UC is challenging, especially in patients who underwent liver transplantation and receive immunosuppressive therapy. Microbiota plays an important role in the pathogenesis of UC, although data on the efficacy of antibiotics in the treatment of UC are limited. We describe the effect of oral vancomycin treatment in three liver transplant recipients with UC refractory to conventional and biological therapy. All three patients achieved clinical remission and mucosal healing with oral vancomycin orally. Oral vancomycin treatment was well tolerated and resulted in sustained clinical and endoscopic remission in all three patients.

Objective. To demonstrate the efficacy of oral vancomycin in the treatment of refractory ulcerative colitis in liver transplant recipients.

Material and methods. The article presents observations of three liver transplant recipients with ulcerative colitis refractory to standard and biological therapy, who received vancomycin orally for 6 months.

Results. Remission of refractory ulcerative colitis in liver recipients was achieved by taking vancomycin orally.

Conclusion. Oral vancomycin administration in some cases lead to clinical and endoscopic remission of ulcerative colitis in recipients in whom standard and biological therapy for UC have not been effective.

Background. Kidney transplant (KT) recipients are a high-risk group for atherosclerotic cardiovascular disease (CVD), closely linked to dyslipidemia.

Objective. To demonstrate the efficacy and safety of a novel proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, inclisiran, for hyperlipidemia correction in and reduction of the risk of developing CVD in KT recipients.

Material and methods. A series of clinical cases included five patients (two men, three women, mean age 56±10 years) with high cardiovascular risk, dyslipidemia, and persistently elevated low-density lipoprotein (LDL) levels, despite ongoing statin and ezetimibe therapy. Inclisiran targeted therapy was prescribed for secondary (4 patients) and primary (1 patient) CVD prevention. Subcutaneous inclisiran injection (284 mg in 1.5 mL solution) was administered in KT department, repeat injection was made after three months, the next injections were performed after 6 months. Dynamic studies of blood LDL, creatinine, tacrolimus levels were performed using standard methods.

Results. Adjunctive inclisiran therapy led to a reduction in blood LDL levels by an average of 32% at two weeks, 40% at one month, and 55% at three months. Continued treatment maintained target LDL values. Inclisiran treatment caused no adverse effects and had no negative impact on transplanted kidney function.

Conclusion. KT recipients with high risk of atherosclerotic CVD represent a promising group for lipid-lowering therapy including inclisiran.

Introduction. The diffuse form of takotsubo cardiomyopathy is extremely rare and even less frequently differentiated from other syndromes. Nevertheless, prompt identification of this condition and a correct emergency care protocol will facilitate proper treatment and minimize complications.

Objective. To describe a case of successful use of veno-arterial extracorporeal membrane oxygenation in a patient with cardiogenic shock due to a rare biventricular form of takotsubo cardiomyopathy.

Material and methods. The patient, a 55-year-old man, without previous history of chronic disease, was admitted for an abruptly arising atypical form of takotsubo syndrome. The clinical Case Report description utilized laboratory and instrumental tests results from the patient's medical record.

Results. The characteristics of the clinical course of the atypical takotsubo syndrome complicated by cardiogenic shock, and the treatment outcomes have been presented.

Conclusions. This clinical case review has demonstrated that the Takotsubo syndrome can manifest itself as a diffuse biventricular dysfunction, leading to a life-threatening cardiogenic shock. A multimodal approach using echocardiography, coronary angiography, and cardiac magnetic resonance imaging played an important role in differential diagnosis to distinguish the disease from an acute coronary syndrome and myocarditis. Mechanical circulatory support served as a successful strategy for a rapid and adequate restoration of cardiac contractility. There is a need for heightened vigilance regarding atypical forms of takotsubo syndrome in patients with cardiogenic shock and non-obstructive coronary arteries.

Background. Currently, liver transplantation remains the most effective method of treating mostly the advanced stages of chronic diffuse liver diseases. The success of liver transplantation depends, in particular, on the adequate choice of a donor liver, timely diagnosis of diffuse changes in the liver graft. In recent years, numerous reports have been published on the use of ultrasound elastometry/elastography and steatometry in the examination of patients with chronic diffuse liver diseases; and there are significantly fewer publications on the use of these methods in liver transplantation.

Objective. To summarize current data on the use of ultrasound elastometry/elastography and steatometry at various stages of liver transplantation.

Material and methods. The analysis of data from foreign and native studies on the use of various methods of ultrasound elastometry/elastography and steatometry in the pre- and postoperative periods during liver transplantation has been performed. The literature data was searched in international databases (PubMed/MedLine/ResearchGate) and in the scientific electronic library of Russia (eLIBRARY.RU) for the period from 2006–2024.

Conclusion. The analyzed publications show the high informative value of ultrasound elastometry/elastography and steatometry in detecting fibrosis and steatosis in donor and transplanted livers, and  capabilities of these methods  in acute liver transplant rejection.

Background. Sarcopenia is a common condition in hospitalized elderly patients, associated with an increased risk of postoperative complications. Computed tomography is the gold standard for diagnosing sarcopenia, but it has a number of limitations. Ultrasound assessment of the thickness of the rectus femoris muscle is a non-invasive and affordable alternative, but its prognostic value in surgical practice has not yet been systematically evaluated.

Objective. To evaluate the diagnostic and prognostic significance of ultrasound measurement of m. rectus femoris thickness in the context of postoperative outcomes in adult patients.

Material and methods. A systematic search of the literature was conducted in the PubMed, EMBASE, Cochrane Library, Scopus, ClinicalTrials.gov, eLIBRARY.RU, and RNMB Registry databases from their inception to April 1, 2025. Fourteen studies with a total of 1.325 participants were included. Inclusion criteria: adult patients (not younger 18 years) who underwent surgery; indication of postoperative complications and ultrasound data on the thickness of the rectus femoris muscle. Studies on children and pregnant women, as well as studies with incorrect methodology, were excluded. The meta-analysis was performed using fixed and random effects models (Mantel–Haenszel, Generic Inverse Variance), and quality was assessed using the Cochrane RoB 1.0 scale.

Results. Based on the results of the meta-analysis, sarcopenia diagnosed by ultrasound of the rectus femoris muscle is associated with an increase in: the length of hospital stay by 4.96 days (95% CI [2.74–7.19]; p<0.0001), length of mechanical ventilation by 2.52 days (95% CI [0.56–4.49]; p=0.01), and 30-day mortality (OR=3.32; 95% CI [2.32–4.75]; p<0.00001).

Conclusions. Ultrasound assessment of m. rectus femoris thickness is a promising tool for preoperative risk stratification. The method demonstrates high clinical significance in predicting complications. Further high-quality RCTs are needed to standardize techniques and validate ultrasound in clinical practice.

Background. Coronary artery disease of the transplanted heart (CADTH) is the most frequent complication and cause of death in patients living more than a year after heart transplantation (HT). The development of effective methods for CADTH prevention remains one of the urgent tasks of transplantology. Up-do-date methods of ex vivo machine perfusion, which allow the CADTH prevention and ensure longer cardiac allograft survival and function.

Objective. To make a review of promising methods for CADTH prevention to prolong the cardiac allograft survival and function.

Material and methods. Sources from 2000 to 2024, retrieved from PubMed, Google Scholar, eLIBRARY.RU.

Conclusion. Prevention of cardiac graft vasculopathy at early stages, namely during ex vivo machine perfusion, allows reducing the risk of the disease onset in the postoperative period. Machine perfusion of the cardiac graft is not only a way of CADTH prevention, but possibly the key way of prolongation of the graft functioning.